Search

Objective: We undertook the present study to attempt to apply clinical indicators predictive of cervical infection in nongravid populations with either Neisseria gonorrhoeae or Chlamydia trachomatis to our pregnant population and to determine the significance of the clinical diagnosis of “cervicitis.”

Abstract Jet mixing is a critical factor in various engineering applications, influencing pollutant dispersion, chemical processes, medical treatments, and combustion enhancement. Hitherto, jet mixing has typically been optimized by either passive or active control techniques. In this experimental study, we combine simultaneous optimization of active control with 12 inward-pointing minijets and a tuneable nozzle exit shape commanded by 12 stepper motors. Jet mixing is monitored at the end of the potential core with an array of 7 $$\times$$ 7 Pitot tubes. This high-dimensional actuation space is conquered with Particle Swarm Optimization through Targeted, Position-Mutated Elitism. Our results underscore the significant impact of combining control techniques, illustrating the complex interactions of both passive and active control on jet flow dynamics. The mixing area of the combined control optimization is 4.5 times larger than the area of the unforced state. This mixing increase significantly outperforms the effect of shape optimization of the nozzle alone. Our study points at the potential of optimization in high-dimensional design spaces for shapes as well as passive and active control—leveraging the rapid development of flow control hardware and the increasingly powerful tools of artificial intelligence for optimization.

Abstract Generating co‐speech gestures for interactive digital humans remains challenging because of the indeterministic nature of the problem. The authors observe that gestures generated from speech audio or text by existing neural methods often contain less movement shift than expected, which can be viewed as slow or dull. Thus, a new generative model coupled with memory networks as dynamic dictionaries for speech‐driven gesture generation with improved diversity is proposed. More specifically, the dictionary network dynamically stores connections between text and pose features in a list of key‐value pairs as the memory for the pose generation network to look up; the pose generation network then merges the matching pose features and input audio features for generating the final pose sequences. To make the improvements more accurately measurable, a new objective evaluation metric for gesture diversity that can remove the influence of low‐quality motions is also proposed and tested. Quantitative and qualitative experiments demonstrate that the proposed architecture succeeds in generating gestures with improved diversity.

Abstract Although the pathogenesis of Alzheimer’s disease (AD) is still unknown, the molecular pathological phenomena is clear, mainly due to mitochondrial dysfunction and central nervous system inflammation caused by imbalanced antioxidant capacity and synaptic dysfunction, so antioxidant therapy is still the preferred treatment for AD. However, although antioxidant enzymes have high catalytic efficiency, the substrate spectrum is narrow; Antioxidants have wider range of effects, but their efficiency is low. Since the antioxidant defense system in high-grade organisms is composed of both enzymatic and non-enzymatic systems, therefore we synthesized a metal-organic framework (MOF) with superoxide dismutase activity, and depending on the interface potential effect, curcumin was loaded to construct a synergistic antioxidant treatment system. More importantly, due to the complementary surface electrostatic potential between MOF and curcumin, the system exhibited both good antioxidant activity and efficient β-amyloid plaque scavenging ability, which slowed down the cognitive dysfunction in the brain of AD mice.

Abstract Emergent superconductivity at the LaAlO3/KTaO3 interfaces exhibits a mysterious dependence on the KTaO3 crystallographic orientations. Here by soft X-ray angle-resolved photoemission spectroscopy, we directly resolve the electronic structure of the LaAlO3/KTaO3 interfacial superconductors and the non-superconducting counterpart. We find that the mobile electrons that contribute to the interfacial superconductivity show strong k ⊥ dispersion. Comparing the superconducting and non-superconducting interfaces, the quasi-three-dimensional electron gas with over 5.5 nm spatial distribution ubiquitously exists and shows similar orbital occupations. The signature of electron-phonon coupling is observed and intriguingly dependent on the interfacial orientations. Remarkably, the stronger electron-phonon coupling signature correlates with the higher superconducting transition temperature. Our observations help scrutinize the theories on the orientation-dependent superconductivity and offer a plausible and straightforward explanation. The interfacial orientation effect that can modify the electron-phonon coupling strength over several nanometers sheds light on the applications of oxide interfaces in general.

The high-temperature gas-cooled reactor (HTGR) with spherical fuel elements contains complex pebble flow. The flow behavior of pebbles is influenced by various factors, such as pebble density, friction coefficient, wall structure, and discharge port size. Using a GPU-DEM numerical model, the effects of the friction coefficient on the cyclic loading and unloading of pebbles in the full-scale HTR-PM are studied. Numerical simulations with up to 420,000 spherical pebbles are conducted. Four sets of friction coefficient values are determined for comparative analysis based on experimental measurements. Discharging speed, residence time, stress, porosity, and velocity distribution are quantitatively analyzed. In addition, a comparison with the CT-PFD experiment is carried out to validate the numerical model. The results show that near-wall retention phenomena are observed in the reactor core only when using large friction coefficients. However, using friction coefficient values closer to the measured experimental values, the pebble bed in HTR-PM exhibited good flow characteristics. Furthermore, the friction coefficient also influences the porosity and velocity distribution of the pebble bed, with lower friction coefficients resulting in lower overall stress in the bed. The discharge outlet's influence varies with different friction coefficient values. In summary, this study demonstrates that the value of the friction coefficient has a complex influence on the pebble flow in HTR-PM, which provides important insights for future numerical and experimental studies in this field.

BACKGROUND/OBJECTIVES: Coffee is one of the most popularly consumed beverages worldwide. Many epidemiological studies have investigated the association between coffee consumption and lung cancer risk, but the results are inconsistent. Hence, we conducted a systematic analysis of relevant population-based studies to examine this association and derive a more precise estimation. SUBJECTS/METHODS: The Cochrane library, PubMed and Embase databases were searched to identify studies published through Mar 2015 that met the predetermined inclusion criterion. Seventeen studies (5 cohort and 12 case-control studies) involving 12 276 cases and 102 516 controls were included. RESULTS: The summary odds ratio (OR) of lung cancer was 1.17 (95% confidence interval (CI): 1.03-1.33) for coffee drinkers compared with nondrinkers and 1.31 (95% CI: 1.11-1.55) for the highest category of coffee consumption compared with the lowest category. Compared with nondrinkers, the pooled ORs for lung cancer were 1.10 (95% CI: 0.92-1.31) for [less than or equal to] 1 cup per day, 1.10 (95% CI: 0.93-1.30) for 2-3 cups per day and 1.20 (95% CI: 1.02-1.39) for ≥ 3 cups per day. Further analysis showed that the ORs for hospital-based case-control studies, population-based case-control studies and prospective cohort studies were 1.36 (95% CI: 1.10-1.69), 0.99 (95% CI: 0.77-1.28) and 1.59 (95% CI: 1.26-2.00), respectively. Significant associations for high coffee intake with increased risk of lung cancer were observed in men (OR = 1.41 95% CI: 1.21-1.63), but not in women (OR = 1.16, 95% CI: 0.86-1.56), in American (OR = 1.34 95% CI: 1.08-1.65) and Asian populations (OR = 1.49 95% CI: 1.28-1.74), but not in European populations (OR = 1.12, 95% CI: 0. 74-1.67), and in smokers (OR = 1.24, 95% CI: 1.00-1.54), but not in nonsmokers (OR = 0.85, 95% CI: 0.64-1.11). Particularly over the last 5 years, studies have consistently indicated that lung cancer risk is significantly increased by 47% in the population with the highest category intake of coffee compared with that with the lowest category intake (OR =1.47, 95% CI: 1.21-1.79). CONCLUSION: The present study suggested that coffee intake was associated with an increased risk of lung cancer. European Journal of Clinical Nutrition (2016) 70, 199-206; doi: 10.1038/ejcn.2015.96; published online 17 June 2015, INTRODUCTION Lung cancer is one of the most prevalent malignancies and is the leading cause of cancer death in the United States, in both men and women. (1) The incidence [...]

Abstract To explore the effect of different levels of systolic blood pressure (SBP) control on new-onset chronic kidney disease in hypertension multimorbidity. The hypertensive patients with multimorbidity information were enrolled from the Kailuan Study. The isolated hypertension patients undergoing physical examination during the same period were selected in a 1:1 ratio as control. Finally, 12,897 participants were divided into six groups: Group SBP

As a kind of renewable and high oxygen content fuel, polyoxymethylene dimethyl ether (PODE) can be added in diesel to realize energy saving and emissions reduction. To evaluate the combustion and emission characteristics of a diesel engine fueled with diesel and diesel/PODE mixtures, exhaust gas recirculation (EGR) and main-pilot injection strategies with various injection timings were applied. PODE was blended with diesel by volume to form mixtures which were marked as D100 (pure diesel), D90P10 (90% diesel + 10% PODE), and D80P20 (80% diesel + 20% PODE). The results showed that the ignition delay (ID) and combustion duration (CD) of D80P20 were the shortest because of the highest cetane number (CN) and high oxygen content of PODE, indicating more concentrated heat release. At low and medium loads, D80P20 achieved the highest peak heat release ratio (PHRR) and peak combustion temperature (PCT) among the three fuels, and it was 14.3% and 3.6% higher than those of D100. PODE blending with diesel can significantly reduce particulate matter (PM) and D80P20 has the lowest PM emissions at all loads. Compared with D100, both PM and nitrogen oxide (NOx) emissions of PODE blends decreased simultaneously with 20% EGR at all loads. With the increase of pilot-main interval, the ID and CD of all test fuels increased, while the NOx and PM emissions decreased. The conclusions of the present research provide a state of the application in light-duty engines fueled with diesel/PODE blends in future work.

Abstract Background Migraine is a neurological disorder characterized by complex, widespread, and sudden attacks with an unclear pathogenesis, particularly in chronic migraine (CM). Specific brain regions, including the insula, amygdala, thalamus, and cingulate, medial prefrontal, and anterior cingulate cortex, are commonly activated by pain stimuli in patients with CM and animal models. This study employs fluorescence microscopy optical sectioning tomography (fMOST) technology and AAV-PHP.eB whole-brain expression to map activation patterns of brain regions in CM mice, thus enhancing the understanding of CM pathogenesis and suggesting potential treatment targets. Methods By repeatedly administering nitroglycerin (NTG) to induce migraine-like pain in mice, a chronic migraine model (CMM) was established. Olcegepant (OLC) was then used as treatment and its effects on mechanical pain hypersensitivity and brain region activation were observed. All mice underwent mechanical withdrawal threshold, light-aversive, and elevated plus maze tests. Viral injections were administered to the mice one month prior to modelling, and brain samples were collected 2 h after the final NTG/vehicle control injection for whole-brain imaging using fMOST. Results In the NTG-induced CMM, mechanical pain threshold decreased, photophobia, and anxiety-like behavior were observed, and OLC was found to improve these manifestations. fMOST whole-brain imaging results suggest that the isocortex-cerebral cortex plate region, including somatomotor areas (MO), somatosensory areas (SS), and main olfactory bulb (MOB), appears to be the most sensitive area of activation in CM (P

Abstract In recent years, aqueous zinc-ion batteries (AZIBs) have attracted significant attention in energy storage due to their notable advantages, including high safety, low cost, high capacity, and environmental friendliness. However, side reactions like hydrogen evolution and zinc (Zn) dendrites can significantly impact their Coulombic efficiency (CE) and lifespan. Effectively addressing these issues has become a focus of research in this field. In our study, dimethyl sulfoxide (DMSO) and nanodiamonds (NDs) were used to optimize the electrolyte of AZIBs. Benefiting from the hydrogen bond fusion of DMSO and NDs, which regulates the Zn deposition behavior, effectively inhibiting the growth of Zn dendrites, hydrogen evolution, and corrosion. The Zn | |Zn symmetric cells using NDs-DMSO-ZS demonstrate exceptional cycling stability for over 1500 h at 1 mA cm− 2, while the Zn//Cu asymmetric cells achieve up to 99.8% CE at 2 mA cm− 2. This study not only shows the application prospects of electrolyte optimization in enhancing AZIBs performance, but also provides a reference for the advancement of electrolyte technology in advanced AZIBs technology.

Abstract Previous research on the syntax complexity variation in individuals with Alzheimer’s disease primarily focuses on isolated language features like sentence length or syntactic structure, with limited exploration of their connection to memory and cognitive deficits. This study investigated the syntactic complexity variation in AD by associating working memory load with fine-grained syntactic features adopting a dependency distance approach. The findings include: (1) AD patients had shorter mean dependency distances (MDD) and more head-final dependencies compared to the HC group; (2) The patients still produced their speech under the DDM tendency but exhibited a stronger preference for simple syntactic structures; (3) Sentences produced by AD patients were statistically shorter than the HC group, and the patients exhibited greater difficulty handling syntactic structures as sentence length increases; (4) The patients could employ different syntactic structures but perform worse in extending them, particularly in nominal groups and hypotactic constructions; (5) The patients showed stronger reliance on sentence-initial adjuncts and inverted constructions. These findings suggest that syntactic impairments in AD exhibit a potential hierarchical decline along the continuum of syntactic complexity, with working memory deficits being a critical factor.

Abstract This study investigated how structural parameters (including injection ducts and exhaust nozzle inner diameters) affect the internal flow field and dilution ratio of diesel particulate sampling diluters. Increasing air injection duct diameter increased the injection chamber pressure and decreased the air velocity peak, mixed gas flow velocity, sample temperature, and mixing rate. Excessively small tube diameters caused uneven and discontinuous flow field distributions, while substantial air blockage rendered the flow state poor. Increasing nozzle inner diameters increased the exhaust flow area and the sample temperature, but decreased the velocity of the exhaust and gas mixtures and the pressure drop. Compared with a 2.0 mm inner diameter, 2.5 and 3.0 mm diameters decreased the peak velocity by 11.18% and 14.41%, respectively, and mixing slowed significantly. Inner nozzle diameters of

Objective: As aging in the Chinese population increases, the hospitalization rates of patients with dementia have also risen. Research on the difficulties of nurses who care for patients with dementia in Chinese general hospitals is limited. This study aimed to develop a scale to measure the difficulties nurses face in nursing patients with dementia in Chinese general hospitals and to verify its reliability and validity. Methods: Guided by the biopsychosocial theory, an initial scale was created through a literature review, qualitative interviews, and expert consultation. A web-based survey for psychometric testing was conducted with 394 nurses from 11 general hospitals during September to November 2021. Validity was verified using content validity, exploratory factor analysis, the known-groups method, and concurrent validity. Cronbach’s α coefficient and split-half reliability were used to assess reliability. Results: The Item-level Content Validity Index was 0.833–1.000. The Scale-level Content Validity Index was 0.929. Twenty-one items with four factors were extracted from the item analysis and exploratory factor analysis. According to the known-groups method, the difficulty of the experienced group and the group with training experience was significantly lower than that of the less experienced group and the group without training experience. Based on external standards, the correlation coefficient was 0.387 with the Nursing Job Stress Scale and −0.239 with the Dementia Care Attitude Scale. Cronbach’s α coefficient for each factor ranged from 0.889 to 0.905, and the total was 0.959. The split-half reliability for each factor ranged from 0.814 to 0.894, and the total was 0.911. Conclusion: This study discovered a four-factor structure related to the difficulty scale of dementia nursing practice, and the scale’s reliability and validity were confirmed. The scale can be utilized to assess the difficulty of dementia nursing practice in general hospitals and may be employed in future research to improve dementia nursing practices.

Abstract Sarcopenia (low muscle mass, i.e., quantity) is associated with poor clinical outcomes in patients with acute-on-chronic liver failure (ACLF). In this study, we aimed to illustrate the clinical prognostic value of myosteatosis (muscle fat infiltration) for short-term mortality in patients with ACLF. We retrospectively enrolled consecutive patients with ACLF between January 2019 and January 2022. Computed tomography-based body composition analysis was performed at the third lumbar vertebral level to determine skeletal muscle radiation attenuation. Fine and Gray’s competing risk regression model, with liver transplantation as a competing risk, was used to assess the factors associated with 90-day mortality. A total of 431 patients with ACLF were included. Myosteatosis and sarcopenia were observed in 261 (60.6%) and 87 (20.2%) patients, respectively. Competitive risk regression showed that age (HR 1.021, 95% CI 1.000–1.043, P = 0.042), APASL ACLF Research Consortium (AARC) score (HR 1.498, 95% CI 1.312–1.710, P

Phosphorus is a key indicator for water quality management due to its role in eutrophication. The variety of phosphorus-containing substances necessitates highly sensitive detection of total phosphorus, particularly through automated methods, to ensure water safety. This study involved the independent development of a sensor featuring an automated in situ detection technique. Utilizing potassium persulfate high-temperature oxidation and phosphorus molybdenum blue spectrophotometry, total phosphorus was monitored in situ via sequential injection technology. Additionally, the detection process and reaction conditions of the sensor were optimized, and a temperature compensation algorithm and turbidity correction were applied to mitigate environmental factors. Under optimal conditions, the sensor demonstrated a detection limit of 1.9 µg/L with a range of 6.5–1000 µg/L in seawater, and 1.2 µg/L with a range of 4.1–2000 µg/L in freshwater. The digestion efficiency for five representative phosphorus-containing substances was found to range from 87.3% ± 1.7% to 103.1% ± 0.6%. Notably, the sensor was deployed for in situ operation at a marine experimental station and online at a river monitoring station. With its integration, low power consumption, and high precision, the sensor enabled long-term unattended monitoring, delivering accurate, stable, and reliable results.

Objective: Acute lower gastrointestinal bleeding is a common emergency in gastroenterology. Currently, there is insufficient information to predict adverse outcomes in patients with acute lower gastrointestinal bleeding. Our study aimed to compare the effectiveness of the clinical risk scores currently utilized and their ability to predict significant outcomes in lower gastrointestinal bleeding. Methods: We conducted a prognostic study of patients hospitalized for acute lower gastrointestinal bleeding who underwent colonoscopy or angiography at a single-center hospital between January 2015 and October 2023. Adverse outcomes associated with ALGIB included rebleeding, blood transfusion, hemostatic interventions, and in-hospital death. We calculated three risk scores at admission (Oakland, Birmingham, SALGIB). We measured the accuracy of these scores using the area under the receiver operating characteristic curve (AUC) and compared them with DeLong's test. Results: 222 patients with confirmed lower gastrointestinal bleeding (aged 64 years, 53–75) were finally included. The most common diagnoses were colorectal cancer (28 %) and hemorrhoids (14 %). The Oakland score, Birmingham score, and SALGIB score displayed comparable performance in predicting any adverse outcome (AUC = 0.54, 0.53, 0.55). However, none of the scores were able to sufficiently discriminate rebleeding, blood transfusion, or hemostatic intervention. Using the Youden index, cutoff points for predicting undesired results were identified for the Oakland score at 13, Birmingham score at 3, and SALGIB score at 2. Conclusions: None of the three scores demonstrated satisfactory discrimination for adverse outcomes. Therefore, it is necessary to develop novel risk stratification scores with higher performance to improve risk stratification in acute lower gastrointestinal bleeding.

Background: Preoperative anxiety in children causes negative postoperative outcomes. Parental presence at induction is a non-pharmacological strategy for relieving anxiety; nevertheless, it is not always possible or effective, namely when parents are overly anxious. Parental presence via video has been demonstrated to be useful in other contexts (divorce, criminal court). This study reports the feasibility of a randomized controlled trial to investigate the effect of video parental presence and parental coaching at induction on preoperative anxiety. Methods: The study was a randomized, 2 × 2 factorial design trial examining parental presence (virtual vs. physical) and coaching (provided vs. not provided). Feasibility was assessed by enrollment rate, attrition rate, compliance, and staff satisfaction with virtual method with the NASA-Task Load Index (NASA-TLX) and System Usability Scale (SUS). For the children's anxiety and postoperative outcomes, the modified Yale Preoperative Anxiety Scale (mYPAS) and Post-Hospitalization Behavioral Questionnaire (PHBQ) were used. Parental anxiety was evaluated with the State-Trait Anxiety Inventory (STAI) questionnaire. Results: A total of 41 parent/patient dyads were recruited. The enrollment rate was 32.2%, the attrition rate 25.5%. Compliance was 87.8% for parents and 85% for staff. The SUS was 67.5/100 and 63.5/100 and NASA-TLX was 29.2 (21.5–36.8) and 27.6 (8.2–3.7) for the anesthesiologists and induction nurses, respectively. No statistically significant difference was found in mYPAS, PHBQ and STAI. Conclusion: A randomized controlled trial to explore virtual parental presence effect on preoperative anxiety is feasible. Further studies are needed to investigate its role and the role of parent coaching in reducing preoperative anxiety.

BACKGROUND: The current understanding of the correlation between TLR4 gene (toll-like receptor 4) rs4986790 and rs4986791 polymorphisms and asthma susceptibility is inconclusive, with studies and populations yielding conflicting results. OBJECTIVES: Evaluate this relationship using meta-analysis and trial sequential analysis (TSA). PATIENTS AND METHODS: Databases were systematically queried for relevant articles from the establishment of the database to 19 June 2023 adhering to predefined inclusion and exclusion criteria. Two authors independently conducted screening, data extraction, and quality evaluation. Meta-analysis and TSA were carried out using RevMan 5.4, StataMP 17.0, and TSA 0.9.5.10 Beta, with α=0.05. Subgroup analyses were conducted based on racial demographics. A sensitivity analysis was conducted employing a one-by-one exclusion method. Publication bias was assessed using the Begg and Egger tests. MAIN OUTCOME MEASURES: Association of asthma susceptibility with TLR4 gene rs4986790 and rs4986791 polymorphisms. SAMPLE SIZE: 23 articles included 22 studies on the rs4986790 polymorphism and 11 studies on the rs4986791 polymorphism on the TLR4 gene. RESULTS: Out of 692 studies screened, 23 met the inclusion criteria. While the overall meta-analysis showed no significant association between the TLR4 rs4986790 polymorphism and asthma susceptibility, subgroup analysis revealed a significant link in the Caucasian population. A significant association was noted in the meta-analysis, particularly among Asian populations, on the rs4986791 polymorphism. The sensitivity analysis indicated that the meta-analysis results were relatively stable. Publication bias analysis revealed minimal influence from publication bias. However, TSA was underscored by the necessity for additional original studies to further validate specific outcomes. CONCLUSIONS: Our study underscores the ethnicity-specific impact on the relationship between TLR4 polymorphisms and asthma susceptibility. While the overall findings for rs4986790 were not significant, the association with the Caucasian population merits further investigation. Furthermore, rs4986791 demonstrated a significant correlation with asthma susceptibility, specifically among Asian populations. LIMITATIONS: Our study predominantly examined the rs4986790 and rs4986791 polymorphisms, overlooking the potential influence of other genetic variants within TLR4.

Abstract Background Pharmacist clinics offer professional pharmaceutical services that can improve public health outcomes. However, primary healthcare staff in China face various barriers and challenges in implementing such clinics. To identify existing problems and provide recommendations for the implementation of pharmacist clinics, this study aims to assess the knowledge, attitudes, and practices of pharmacist clinics among primary healthcare providers. Methods A cross-sectional survey based on the Knowledge-Attitude-Practice (KAP) model, was conducted in community health centers (CHCs) and private hospitals in Shanghai, China in May, 2023. Descriptive analytics and the Pareto principle were used to multiple-answer questions. Chi-square test, Fisher’s exact test, and binary logistic regression models were employed to identify factors associated with the knowledge, attitudes, and practices of pharmacist clinics. Results A total of 223 primary practitioners participated in the survey. Our study revealed that most of them had limited knowledge (60.1%, n = 134) but a positive attitude (82.9%, n = 185) towards pharmacist clinics, with only 17.0% (n = 38) having implemented them. The primary goal of pharmacist clinics was to provide comprehensive medication guidance (31.5%, n = 200), with medication education (26.3%, n = 202) being the primary service, and special populations (24.5%, n = 153) identified as key recipients. Logistic regression analysis revealed that education, age, occupation, position, work seniority, and institution significantly influenced their perceptions. Practitioners with bachelor’s degrees, for instance, were more likely than those with less education to recognize the importance of pharmacist clinics in medication guidance (aOR: 7.130, 95%CI: 1.809–28.099, p-value = 0.005) and prescription reviews (aOR: 4.675, 95% CI: 1.548–14.112, p-value = 0.006). Additionally, practitioners expressed positive attitudes but low confidence, with only 33.3% (n = 74) feeling confident in implementation. The confidence levels of male practitioners surpassed those of female practitioners (p-value = 0.037), and practitioners from community health centers (CHCs) exhibited higher confidence compared to their counterparts in private hospitals (p-value = 0.008). Joint physician-pharmacist clinics (36.8%, n = 82) through collaboration with medical institutions (52.0%, n = 116) emerged as the favored modality. Daily sessions were preferred (38.5%, n = 86), and both registration and pharmacy service fees were considered appropriate for payment (42.2%, n = 94). The primary challenge identified was high outpatient workload (30.9%, n = 69). Conclusions Although primary healthcare practitioners held positive attitudes towards pharmacist clinics, limited knowledge, low confidence, and high workload contributed to the scarcity of their implementation. Practitioners with diverse sociodemographic characteristics, such as education, age, and institution, showed varying perceptions and practices regarding pharmacist clinics.

Abstract Stretchable phosphorescence materials potentially enable applications in diverse advanced fields in wearable electronics. However, achieving room-temperature phosphorescence materials simultaneously featuring long-lived emission and good stretchability is challenging because it is hard to balance the rigidity and flexibility in the same polymer. Here we present a multiphase engineering for obtaining stretchable phosphorescent materials by combining stiffness and softness simultaneously in well-designed block copolymers. Due to the microphase separation, copolymers demonstrate an intrinsic stretchability of 712%, maintaining an ultralong phosphorescence lifetime of up to 981.11 ms. This multiphase engineering is generally applicable to a series of binary and ternary initiator systems with color-tunable phosphorescence in the visible range. Moreover, these copolymers enable multi-level volumetric data encryption and stretchable afterglow display. This work provides a fundamental understanding of the nanostructures and material properties for designing stretchable materials and extends the potential of phosphorescence polymers.

Abstract Background There is still limited research on the prognostic value of Presepsin as a biomarker for predicting the outcome of COVID-19 patients. Additionally, research on the combined predictive value of Presepsin with clinical scoring systems and inflammation markers for disease prognosis is lacking. Methods A total of 226 COVID-19 patients admitted to Beijing Youan Hospital’s emergency department from May to November 2022 were screened. Demographic information, laboratory measurements, and blood samples for Presepsin levels were collected upon admission. The predictive value of Presepsin, clinical scoring systems, and inflammation markers for 28-day mortality was analyzed. Results A total of 190 patients were analyzed, 83 (43.7%) were mild, 61 (32.1%) were moderate, and 46 (24.2%) were severe/critically ill. 23 (12.1%) patients died within 28 days. The Presepsin levels in severe/critical patients were significantly higher compared to moderate and mild patients (p

Abstract A retrospective cohort study was conducted to observe the correction effect of Toric intraocular lens (IOL) implantation in cataract eyes with specific types of irregular corneal astigmatism. Thirty-four eyes with either the "asymmetric bow-tie" pattern (Type I) or the "angled bow-tie" pattern (Type II) were included. Corneal topography was assessed using Pentacam HR, and changes in preoperative corneal astigmatism, visual acuity, manifest refraction, and objective visual quality were measured and compared. The average uncorrected distance visual acuity improved significantly from 0.86 ± 0.40 logMAR to 0.22 ± 0.15 logMAR (P

Abstract The structural characteristics of plant communities in urban green spaces have a significant impact on their carbon sequestration function. In this study, comprehensive data were collected from 106 plant communities (each 20 m × 20 m) in Zhengzhou Green Expo Park. We assessed aboveground and soil carbon storage, alongside maintenance carbon emissions, to quantify carbon dynamics. Our primary objective was to establish a statistical model that correlates the structural attributes of plant communities with their total annual carbon sequestration. This model aims to provide a quantitative framework for optimizing community structures to maximize carbon sequestration in urban green spaces. The results showed that density and coverage were significantly and positively correlated with aboveground and soil carbon stocks. Density and mean height were significantly and positively correlated with maintenance carbon emissions. Density played a key structural role in regulating the total carbon sequestration of the plant communities, being 27.24 times more effective than coverage. The total annual carbon sequestration of the plant community reached an optimal value of 327.67 kg CO2-eq/y−1 at a density and cover of 0.15 and 1, respectively. This study provides valuable data for increasing the carbon sink ability of urban green spaces through plant structure regulation and supporting low-carbon development strategies in urban management.

Abstract The objectives of this study were to explore the changes in soil stoichiometry and enzyme activities at different distances from an opencast coal mine in the Hulun Buir Grassland of China. Four transects were established on north and east sides of the opencast coal mining area, and samples were collected at 50 m, 550 m, and 1550 m from the pit on each transect. Control samples were collected from a grassland station 8 km from the opencast coal mining area that was not disturbed by mining. Four replicate soil samples were collected at each point on the four transects. Soil physicochemical properties and enzyme activities were determined, and correlations between soil properties and stoichiometric ratios and enzyme activities were explored using redundancy analysis. The increase in distance from mining did not significantly affect soil properties, although soil urease activity was significantly lower than that of the control area. Soil properties 1550 m from the mine pit were similar to those at the grassland control. In addition, soil total nitrogen had the greatest effect on soil stoichiometry, and soil total potassium had the greatest effect on soil enzyme activities. Coal dust from opencast mining might be the main factor affecting soil stoichiometry and enzyme activities. The results of this study provide direction for the next step in studying the influence of mining areas on soil properties and processes.

Abstract Dynamic luminescence behavior by external stimuli, such as light, thermal field, electricity, mechanical force, etc., endows the materials with great promise in optoelectronic applications. Upon thermal stimulus, the emission is inevitably quenched due to intensive non-radiative transition, especially for phosphorescence at high temperature. Herein, we report an abnormal thermally-stimulated phosphorescence behavior in a series of organic phosphors. As temperature changes from 198 to 343 K, the phosphorescence at around 479 nm gradually enhances for the model phosphor, of which the phosphorescent colors are tuned from yellow to cyan-blue. Furthermore, we demonstrate the potential applications of such dynamic emission for smart dyes and colorful afterglow displays. Our results would initiate the exploration of dynamic high-temperature phosphorescence for applications in smart optoelectronics. This finding not only contributes to an in-depth understanding of the thermally-stimulated phosphorescence, but also paves the way toward the development of smart materials for applications in optoelectronics.

Abstract Background Energy metabolism disorders and neurogenic inflammation play important roles in the central sensitization to chronic migraine (CM). AMP-activated protein kinase (AMPK) is an intracellular energy sensor, and its activation regulates inflammation and reduces neuropathic pain. However, studies on the involvement of AMPK in the regulation of CM are currently lacking. Therefore, this study aimed to explore the mechanism underlying the involvement of AMPK in the central sensitization to CM. Methods Mice with recurrent nitroglycerin (NTG)-induced CM were used to detect the expression of AMPK protein in the trigeminal nucleus caudalis (TNC). Following intraperitoneal injection of the AMPK activator 5-aminoimidazole-4-carboxyamide ribonucleoside (AICAR) and inhibitor compound C, the mechanical pain threshold, activity level, and pain-like behaviors in the mice were measured. The expression of calcitonin gene-related peptide (CGRP) and cytokines, M1/M2 microglia, and NF-κB pathway activation were detected after the intervention. Results Repeated NTG injections resulted in a gradual decrease in AMPK protein expression, and the negative regulation of AMPK by increased ubiquitin-like plant homeodomain and RING finger domain 1 (UHRF1) expression may counteract AMPK activation by increasing ADP/ATP. AICAR can reduce the hyperalgesia and pain-like behaviors of CM mice, improve the activity of mice, reduce the expression of CGRP, IL-1β, IL-6, and TNF-α in the TNC region, and increase the expression of IL-4 and IL-10. Moreover, AMPK in TNC was mainly located in microglia. AICAR could reduce the expression of inducible NO synthase (iNOS) in M1 microglia and increase the expression of Arginase 1 (Arg1) in M2 microglia by inhibiting the activation of NF-κB pathway. Conclusions AMPK was involved in the central sensitization of CM, and the activation of AMPK reduced neuroinflammation in NTG-induced CM mice. AMPK may provide new insights into interventions for energy metabolism disorders and neurogenic inflammation in migraine.

Presents useful tips for improving classroom learning. These include inviting native- and nonnative-English-speaking students to engage in world building while improving their language and cultural knowledge; highly motivated conversational activities; students' revision of their oral presentations; having students record classroom activities; and using linguistic puzzles. (Author/CK)

Digestive-system cancers represent major threats to human health; however, the mechanisms underlying tumorigenesis and radiochemotherapy resistance have remained elusive. Therefore, an urgent need exists for identifying key drivers of digestive system tumorigenesis and novel targeted therapeutics. The checkpoint kinase 2 (Chk2) regulates cell-cycle progression, and Chk2 dysregulation or Chk2 mutations can lead to the development of various cancers, which makes Chk2 an important research topic. This review summarizes the roles of Chk2 in DNA-damage responses, cell-cycle regulation, autophagy, and homeostasis maintenance. We describe relationships between tumorigenesis and cell-cycle dysregulation induced by Chk2 mutations. In addition, we summarize evidence indicating that Chk2 can serve as a novel therapeutic target, based on its contributions to radiochemotherapy-resistance reversion and progress made in developing antitumor agents against Chk2. The prevailing evidence supports the conclusion that further research on Chk2 will provide a deeper understanding of digestive-system tumorigenesis and should suggest novel therapeutic targets.

Background Since the outbreak of coronavirus disease 2019 (COVID-19), studies have found correlations between blood cell count-derived inflammatory markers (BCDIMs) and disease severity and prognosis in COVID-19 patients. However, there is currently a lack of systematic comparisons between procalcitonin (PCT), C-reactive protein (CRP), C-reactive protein-to-albumin ratio (CAR) and BCDIMs for assessing the severity and prognosis of COVID-19 patients.Methods A total of 1040 COVID-19 patients were included in the study. Demographics, comorbidities and laboratory results were analysed. BCDIMs refer to the following ratios: neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-C-reactive protein ratio (LCR), systemic inflammation response index (SIRI) and systemic inflammation index (SII). Disease severity and 28-day mortality are clinical outcomes of this study. Area under the curve (AUC) of receiver operating characteristic (ROC) curve was calculated for these markers, and DeLong’s test compared their statistical differences. Cox regression analysis assessed their predictive value for the 28-day mortality rate.Results Among the 1040 patients, 35.3% were severe/critical, 49.6% were moderate and 15.1% were mild cases. Within 28 days, 15.1% died. The NLR had the highest predictive value for disease severity (AUC: 0.790, 95% CI: 0.762–0.818). NLR differed significantly from other markers, except LCR. LCR best predicted 28-day mortality (AUC: 0.798, 95% CI: 0.766–0.829). Some markers showed significant differences in AUC with LCR. Multivariable Cox regression identified BCDIMs, PCT, CRP and CAR as significant risk factors for 28-day mortality.Conclusions PCT, CRP, CAR and BCDIMs, easily obtained in clinical settings, are valuable predictors of disease severity and the 28-day mortality in COVID-19 patients. The NLR is particularly effective for disease severity, while the LCR is highly predictive of 28-day mortality. These markers provide guidance for stratified management of COVID-19 patients.

This study examines the uniaxial compressive mechanical properties of after high temperature bamboo scrimber, taking into account the combined effects of temperature, constant temperature duration, and moisture content. A series of 46 uniaxial compression tests were conducted on bamboo scrimber under various conditions to investigate the failure modes after high temperatures. The analysis focuses on the changes in compressive elastic modulus and peak stress of bamboo scrimber parallel and perpendicular to the grain, in relation to temperature, constant temperature duration, and moisture content. The findings reveal that below 180℃, diagonal shear failure and Y-type shear failure are the primary failure modes for specimens parallel to the grain, while diagonal shear failure predominates for specimens perpendicular to the grain. Above 180℃, bond failure and eccentric crushing become the main failure modes for specimens parallel and perpendicular to the grain, respectively. The peak compressive stress decreases significantly beyond 180℃, with a slower decrease observed as moisture content increases. Constant temperature duration has a notable impact on peak stress, with longer durations resulting in lower peak stress at the same temperature. Although temperature has a lesser effect on the elastic modulus compared to peak stress, empirical formulas were derived to establish the relationship between compressive elastic modulus and peak stress reduction coefficient with variations in temperature, constant temperature duration, and moisture content based on the experimental data.

ABSTRACTAlthough the role of the intestinal microbiota in the pathogenesis of inflammatory bowel disease (IBD) is beyond debate, attempts to verify the causative role of IBD-associated dysbiosis have been limited to reports of promoting the disease in genetically susceptible mice or in chemically induced colitis. We aimed to further test the host response to fecal microbiome transplantation (FMT) from Crohn’s disease patients on mucosal homeostasis in ex-germ-free (xGF) mice. We characterized and transferred fecal microbiota from healthy patients and patients with defined Crohn’s ileocolitis (CD_L3) to germ-free mice and analyzed the resulting microbial and mucosal homeostasis by 16S profiling, shotgun metagenomics, histology, immunofluorescence (IF) and RNAseq analysis. We observed a markedly reduced engraftment of CD_L3 microbiome compared to healthy control microbiota. FMT from CD_L3 patients did not lead to ileitis but resulted in colitis with features consistent with CD: a discontinued pattern of colitis, more proximal colonic localization, enlarged isolated lymphoid follicles and/or tertiary lymphoid organ neogenesis, and a transcriptomic pattern consistent with epithelial reprograming and promotion of the Paneth cell-like signature in the proximal colon and immune dysregulation characteristic of CD. The observed inflammatory response was associated with persistently increased abundance of Ruminococcus gnavus, Erysipelatoclostridium ramosum, Faecalimonas umbilicate, Blautia hominis, Clostridium butyricum, and C. paraputrificum and unexpected growth of toxigenic C. difficile, which was below the detection level in the community used for inoculation. Our study provides the first evidence that the transfer of a dysbiotic community from CD patients can lead to spontaneous inflammatory changes in the colon of xGF mice and identifies a signature microbial community capable of promoting colonization of pathogenic and conditionally pathogenic bacteria.

Objective The study aimed to investigate the correlation and consistency between resting full-cycle ratio (RFR) and fractional flow reserve (FFR) in functional assessment of coronary arteries in a Chinese real-world cohort with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Design Retrospective study.Setting A single-centre study in China.Participants A total of 292 diseased vessels of 226 Chinese patients with NSTE-ACS at Cangzhou Central Hospital of Hebei Medical University from September 2021 to June 2023 were included.Methods The correlation between RFR and FFR, resting ratio of distal coronary artery pressure (Pd) to aortic pressure (Pa) and FFR were analysed by using Person correlation, and the consistency between RFR and FFR, resting Pd/Pa and FFR were assessed by Bland-Altman test. The diagnostic values of RFR and resting Pd/Pa for predicting FFR≤0.80 were evaluated according to the receiver operating characteristic (ROC) curves.Results RFR and resting Pd/Pa were significantly correlated with FFR, and correlation coefficients were 0.787 (p

Introduction: Polymyxin B is widely used to treat infections caused by multidrug-resistant Gram-negative bacteria. However, the pharmacokinetic study data of PB in the elderly are scarce. Herein, a simple method to measure the concentration of PB in human plasma was developed and validated by high performance liquid chromatography—tandem mass spectrometry, and it was applied to a PK study in the elderly.Methods: PB was extracted from human plasma by a rapid protein-precipitation method using 0.1% formic acid in methanol and then separated on an ultimate AQ-C18 column using linear gradient elution with a 0.5-mL/min flow rate. Subsequently, PB was detected using a mass spectrometer operated in positive-ion and multiple-reaction-monitoring modes.Results: The lower limits of quantification of the method for Polymyxin B1 and Polymyxin B2 were 1.00 and 0.10 μg/mL, respectively. The linear ranges for PB1 and PB2 were 1.00–20.02 and 0.10–2.04 μg/mL, respectively. Patients receiving a 75-mg maintenance dose every 12h had AUCss, 24 h, and Css, av values of 117.70 ± 37.03 μg h/mL and 4.14 ± 1.74 μg/mL, respectively. For patients receiving a 100 mg maintenance dose, these values were 152.73 ± 70.09 μg h/mL and 5.43 ± 2.85 μg/mL, respectively.Conclusion: The validated HPLC–MS/MS method was successfully applied to a study on the pharmacokinetics of PB in elderly patients infected with multidrug-resistant Gram-negative bacteria. Both two dose strategies in this study would have a excessive PB exposure in the elderly patients then the therapeutic window recommended by guidelines.

ABSTRACT Soil microorganisms are the most active participants in terrestrial ecosystems, and have key roles in biogeochemical cycles and ecosystem functions. Despite the extensive research on soil pH as a key predictor of microbial community and composition, a limitation of these studies lies in determining whether bacterial and/or fungal communities are directly or indirectly influenced by pH. We conducted a controlled laboratory experiment to investigate the effects of soil pH amendment (+/- 1–2 units) with six levels on soil microbial communities in two contrasting Chinese agricultural soils (pH 8.43 in Dezhou, located in the North China Plain, Shandong vs pH 6.17 in Wuxi, located in the Taihu Lake region, Jiangsu, east China). Results showed that the fungal diversity and composition were related to soil pH, but the effects were much lower than the effects of soil pH on bacterial community in two soils. The diversity and composition of bacterial communities were more closely associated with soil pH in Wuxi soils compared to Dezhou soils. The alpha diversity of bacterial communities peaked near in situ pH levels in both soils, displaying a quadratic fitting pattern. Redundancy analysis and variation partition analysis indicated that soil pH affected bacterial community and composition by directly imposing a physiological constraint on soil bacteria and indirectly altering soil characteristics (e.g., nutrient availability). The study also examined complete curves of taxa relative abundances at the phylum and family levels in response to soil pH, with most relationships conforming to a quadratic fitting pattern, indicating soil pH is a reliable predictor. Furthermore, soil pH amendment affected the transformation of nitrogen and the abundances of functional genes involved in the nitrogen cycle, and methane production and consumption. Overall, results from this study would enhance our comprehension of how soil microorganisms in contrasting farmlands will respond to soil pH changes, and would contribute to more effective soil management and conservation strategies.IMPORTANCEThis study delves into the impact of soil pH on microbial communities, investigating whether pH directly or indirectly influences bacterial and fungal communities. The research involved two contrasting soils subjected to a 1–2 pH unit amendment. Results indicate bacterial community composition was shaped by soil pH through physiological constraints and nutrient limitations. We found that most taxa relative abundances at the phylum and family levels responded to pH with a quadratic fitting pattern, indicating that soil pH is a reliable predictor. Additionally, soil pH was found to significantly influence the predicted abundance of functional genes involved in the nitrogen cycle as well as in methane production and consumption processes. These insights can contribute to develop more effective soil management and conservation strategies.

In recent years, microplastics, especially marine microplastic pollution, have received global attention as a new type of environmental problem. The establishment of accurate and efficient methods for the detection of microplastics is the basis for in-depth research on the transport, transformation, fate, and ecotoxicological effects of microplastics in the environment. Microplastics in seawater frequently mix with biological tissues, resulting in challenges when identifying samples. However, commonly used pretreatment protocols for microplastics often suffer from long digestion times, inadequate digestion, and the risk of potentially damaging microplastics. This study compared the digestion efficiencies of five digestion reagents and provided further insights into two advanced oxidation methods involving Fenton’s reagent and an innovative alkaline K2S2O8 protocol based on sulfate and hydroxyl radicals. Using Raman spectroscopy, scanning electron microscopy-energy dispersive spectroscopy (SEM−EDS), and carbonyl index (CI) analyses, the status of microplastics after pretreatment was evaluated. The results revealed that the alkaline K2S2O8 method could enhance the reaction efficiency while reducing the potential for functional group damage during microplastic pretreatment. Moreover, the proposed K2S2O8 method was applied to the pretreatment of field seawater samples, and field microplastics were effectively separated from biologically rich samples. Thus, a digestion protocol based on alkaline K2S2O8 provides an effective way to isolate seawater microplastics from biologically rich samples. This study contributes to the development of efficiently microplastic monitoring and provides valuable insights into access to reliable data for fate and inventory of oceanic microplastics.

Cadmium (Cd) contamination poses a significant threat to agricultural soils and food safety, necessitating effective remediation strategies. Salix species, with their high coverage and Cd accumulating capacity, hold promise for remediation efforts. The rhizosphere microbiome is crucial for enhancing Cd accumulating capacity for Salix. However, the mechanisms by how Salix interacts with its rhizosphere microbiome to enhance Cd extraction remains poorly understood. In this study, we compared the remediation performance of two Salix ecotypes: 51–3 (High Cd-accumulating Ecotype, HAE) and P646 (Low Cd-accumulating Ecotype, LAE). HAE exhibited notable advantages over LAE, with 10.80 % higher plant height, 43.80 % higher biomass, 20.26 % higher Cd accumulation in aboveground tissues (93.09 μg on average), and a superior Cd translocation factor (1.97 on average). Analysis of the rhizosphere bacterial community via 16S rRNA amplicon sequencing revealed that HAE harbored a more diverse bacterial community with a distinct composition compared to LAE. Indicator analysis identified 84 genera specifically enriched in HAE, predominantly belonging to Proteobacteria, Actinobacteria, and Firmicutes, including beneficial microbes such as Streptomyces, Bacillus, and Pseudomonas. Network analysis further elucidated three taxa groups specifically recruited by HAE, which were highly correlated with functional genes that associated with biosynthesis of secondary metabolites, glycan biosynthesis and metabolism, and metabolism of cofactors and vitamins. These functions contribute to enhancing plant growth, Cd uptake, and resistance to Cd in Salix. Overall, our findings highlight the importance of the rhizosphere microbiome in facilitating Cd extraction and provide insights into microbiome-based strategies for sustainable agricultural practices.

This study introduces the concept of nonlocal effect into a monoatomic mass–spring periodic structure, leading to unique characteristics of dispersion curves. Through the incorporation of the second neighboring nonlocal effect, we have observed the emergence of negative group velocity and specific points with zero group velocity (ZGV) within the dispersion curves. By harnessing the distinctive property of ZGV, we successfully attained the localization of transmission at specific frequencies, leading to a rainbow trapping effect. Notably, with the appropriate tuning of the third neighboring nonlocal effect, we observe that multi-frequency can be localized at predetermined positions. Waves under these frequencies are trapped at the same location, demonstrating a multi-frequency rainbow trapping phenomenon. The results from this research provide a novel perspective on elastic wave manipulation in periodic structures, with potential implications for the design of advanced materials and devices.

As the financialization issue is getting more and more attention, the behavioral motives and effects behind this appearance should not be ignored, and it is of great practical significance for the high-quality development of China's real economy to explore the impact and mechanism of the financialization trend on the investment and financing maturity mismatch of China's real enterprises. Using sample data of Chinese A-share listed companies from 2013 to 2020, this article empirically examines the impact of financialization on the investment and financing maturity structure from a new perspective of asset classification by using a fixed-effect model, and explores the mechanism of the financial regulatory environment's moderating effect on the relationship between the two mentioned above. The study shows that: there is an inverted U-shaped nonlinear relationship between the financialization of investment income and fixed income and “maturity mismatch “. The term mismatch of investment and financing increases with the degree of financialization, after reaching the critical point, it eases with the deepening of financialization. However, the specific point of view is different. In the sample interval, the investment income financialization exacerbates the investment and financing maturity mismatch more obviously; the fixed income financialization inhibits the investment and financing maturity mismatch more obviously. Under the different perspectives of the firms' ownership nature, financing constraints, and principal-agent problems, there are differences in the impact of firms' allocation of different types of financial assets on the investment and financing term structure. In addition, the regulatory effect of financial supervision weakens the inverted U-shaped relationship of investment income financialization with investment and financing maturity mismatch; it enhances the inverted U-shaped relationship between fixed income financialization and investment and financing maturity mismatch. In general, financial supervision has had a significant positive effect on investment and financing maturity mismatches. The findings have important policy implications in terms of corporate real investment, financial market development, and financial regulation, which can help promote China's economic development and stability.

Background: Patient-ventilator asynchrony (PVA) frequently occurs in mechanically ventilated patients within the ICU and has the potential for harm. Depending solely on the health care team cannot accurately and promptly identify PVA. To address this issue, our team has developed a cloud-based platform for monitoring mechanical ventilation (MV), comprising the PVA-RemoteMonitor system and the 24-h MV analysis report. We conducted a survey to evaluate physicians' satisfaction and acceptance of the platform in 14 ICUs. Methods: Data from medical records, clinical information systems, and ventilators were uploaded to the cloud platform and underwent data processing. The data were analyzed to monitor PVA and displayed in the front-end. The 24-h analysis report for MV was generated for clinical reference. Critical care physicians in 14 hospitals' ICUs that involved in the platform participated in a questionnaire survey, among whom 10 physicians were interviewed to investigate physicians’ acceptance and opinions of this system. Results: The PVA-RemoteMonitor system exhibited a high level of specificity in detecting flow insufficiency, premature cycle, delayed cycle, reverse trigger, auto trigger, and overshoot, with sensitivities of 90.31 %, 98.76 %, 99.75 %, 99.97 %, 100 %, and 99.69 %, respectively. The 24-h analysis report supplied essential data about PVA and respiratory mechanics. 86.2 % (75/87) of physicians supported the application of this platform. Conclusions: The PVA-RemoteMonitor system accurately identified PVA, and the MV analysis report provided guidance in controlling PVA. Our platform can effectively assist ICU physicians in the management of ventilated patients.

Summary: Background: Furmonertinib showed superior efficacy compared with gefitinib as first-line therapy in patients with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) in the FURLONG study. Here we present prespecified secondary endpoints of patient-reported outcomes (PRO). Methods: In this multicentre, double-blind, double-dummy, randomised phase 3 study, patients were 1:1 randomly assigned to receive furmonertinib 80 mg once daily or gefitinib 250 mg once daily. PROs assessed by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and Quality-of-Life Questionnaire Lung Cancer 13 were analysed using a mixed model for repeated measures and time-to-event analyses. A difference in score of 10 points or more was deemed clinically relevant. Findings: Three hundred and fifty-seven patients (furmonertinib group, n = 178; gefitinib group, n = 179) received at least one dose of the study drug, all of whom completed at least one PRO assessment. Statistically significant difference of overall score changes from baseline favoured furmonertinib in physical functioning (between-group difference 2.14 [95% CI 0.25–4.04], p = 0.027), nausea/vomiting (−1.56 [95% CI −2.62 to −0.49], p = 0.004), appetite loss (−2.24 [95% CI −4.26 to −0.23], p = 0.029), diarrhoea (−3.36 [95% CI −5.19 to −1.54], p < 0.001), alopecia (−2.62 [95% CI −4.54 to −0.71], p = 0.007), and pain in other parts (−4.55 [95% CI −7.37 to −1.74], p = 0.002), but not reached clinical relevance. Time to deterioration in physical functioning (hazard ratio 0.63 [95% CI 0.42–0.94], p = 0.021), cognitive functioning (0.73 [95% CI 0.54–0.98], p = 0.034), nausea/vomiting (0.64 [95% CI 0.41–0.99], p = 0.042), appetite loss (0.63 [95% CI 0.43–0.92], p = 0.016), diarrhoea (0.63 [95% CI 0.46–0.85], p = 0.002), dyspnoea (0.72 [95% CI 0.53–0.98], p = 0.034), cough (0.67 [95% CI 0.44–1.00], p = 0.049), dysphagia (0.54 [95% CI 0.35–0.83], p = 0.004), and alopecia (0.62 [95% CI 0.42–0.90], p = 0.012) was longer with furmonertinib versus gefitinib. Interpretation: In patients with locally advanced or metastatic EGFR mutation-positive NSCLC, furmonertinib showed improved scores and delayed deterioration in several functioning and symptoms compared to gefitinib. Funding: Shanghai Allist Pharmaceutical Technology Co., Ltd and the National Science and Technology Major Project for Key New Drug Development (2017ZX09304015).

Bamboo scrimber (BS) is a novel renewable biocomposite material with excellent mechanical performance and stability that is suitable for load-bearing structural members. Beam-type components are among the most widely used members in structural engineering, and their flexural behaviour is crucial for the safety and applicability of structures. Based on a review of the existing literature, this article presents a comprehensive overview and discussion of the research and development of various forms of beam-type BS members with the aim of reaching a clearer understanding of the bending mechanisms and mechanical characteristics of BS beams. The members highlighted in this review include general BS beams, reinforced BS beams (with steel bars and fibre-reinforced polymer plates), composite BS beams (with profile steel and concrete), and strengthened damaged BS beams. Moreover, the factors affecting the flexural performance of BS beams, such as span-depth ratios, their mechanical properties, and reinforcing materials, are analysed quantitatively. Finally, the calculation models for the flexural bearing capacity and stiffness of BS beams are summarised and compared. This review aims to illustrate the potential of BS in the field of structural engineering and provide references for future research and design methods for BS flexural members.

IntroductionIn the United States, firearm-related injuries are the leading cause of death among children and adolescents 1–19 years of age. Although many pediatricians believe addressing firearm safety is important and have guidance from organizations like the American Academy of Pediatrics, few routinely screen and counsel on firearm safety. The goal of this project was to screen all patients presenting to the pediatric emergency department, pediatric floor, and pediatric intensive care unit for the presence of firearms in the home, firearm storage practices, and whether they had previously received any firearm counseling by medical professionals.MethodsA 13-item survey was administered to each participant. Items included demographic information, willingness to answer questions about firearms, practice of asking questions about firearms, previous counseling from medical professionals about the presence of firearms in the home and the presence of firearm in their personal home as well as storage practices.ResultsA total of 200 parents responded to the survey. Of those that responded to the survey, 171 (85.5%) did not have a firearm in the home and 28 (14%) did have a firearm in the home. 75% (n = 21) had never had a medical provider discuss firearm safety with them. 100% had never been asked by another parent about the presence of a firearm in their home when a child came over for a playdate. 39% (n = 11) of parents with a firearm in the home had asked other parents whether they have a firearm in the home where their child goes to play.DiscussionFindings from our study highlight a significant lack of screening of our pediatric patients both in the inpatient and outpatient settings, with the majority reporting that they had never been asked by a medical provider about firearm safety. In addition, three quarters of parents with a firearm in the home reported that they did not mind answering questions about firearms yet none had been asked by other parents about firearms. Thus, although firearm possession and safety is considered to be a sensitive topic, many parents are willing to discuss it with their health care providers and other parents.

Background: The expansion of artificial intelligence (AI) within large language models (LLMs) has the potential to streamline healthcare delivery. Despite the increased use of LLMs, disparities in their performance particularly in different languages, remain underexplored. This study examines the quality of ChatGPT responses in English and Japanese, specifically to questions related to anaesthesiology. Methods: Anaesthesiologists proficient in both languages were recruited as experts in this study. Ten frequently asked questions in anaesthesia were selected and translated for evaluation. Three non-sequential responses from ChatGPT were assessed for content quality (accuracy, comprehensiveness, and safety) and communication quality (understanding, empathy/tone, and ethics) by expert evaluators. Results: Eight anaesthesiologists evaluated English and Japanese LLM responses. The overall quality for all questions combined was higher in English compared with Japanese responses. Content and communication quality were significantly higher in English compared with Japanese LLMs responses (both P

Delayed neuropsychiatric sequelae (DNS) significantly impact the quality of life in patients following acute carbon monoxide poisoning (COP). This systematic review and meta-analysis aimed to assess the relationship between serum neuron-specific enolase (NSE) levels at admission and the risk of DNS in adults after acute COP. Relevant observational studies with longitudinal follow-up were identified through searches in PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure databases. The random-effects model was used to aggregate results, accounting for potential heterogeneity. Nine cohort studies, including 1501 patients, were analyzed, with 254 (16.9%) developing DNS during follow-up. The pooled data indicated that elevated serum NSE in the early phase was linked to a higher risk of subsequent DNS (odds ratio per 1 ng/mL increase in NSE: 1.10, 95% confidence interval: 1.06 to 1.15, P < 0.001). Moderate heterogeneity (I2 = 46%) among the studies was entirely attributed to one study with the longest follow-up duration (22.3 months; I2 = 0% after excluding this study). Subgroup analyses based on country, study design, sample size, age, sex, admission carboxyhemoglobin levels, DNS incidence, follow-up duration, and quality score yielded consistent results (P for subgroup differences all > 0.05). In summary, high serum NSE levels in the early phase of acute COP are associated with an increased risk of developing DNS during follow-up.

Background: Patients are increasingly using artificial intelligence (AI) chatbots to seek answers to medical queries. Methods: Ten frequently asked questions in anaesthesia were posed to three AI chatbots: ChatGPT4 (OpenAI), Bard (Google), and Bing Chat (Microsoft). Each chatbot's answers were evaluated in a randomised, blinded order by five residency programme directors from 15 medical institutions in the USA. Three medical content quality categories (accuracy, comprehensiveness, safety) and three communication quality categories (understandability, empathy/respect, and ethics) were scored between 1 and 5 (1 representing worst, 5 representing best). Results: ChatGPT4 and Bard outperformed Bing Chat (median [inter-quartile range] scores: 4 [3–4], 4 [3–4], and 3 [2–4], respectively; P